Tuesday, 17 June 2008

Funding for health services

One of the comments on my last post about smuggling cigarettes ("Risk free or duty free?") suggested increasing the taxes on cigarettes in Gibraltar and added that the additional revenue generated could go directly towards treating smokers. (With which I do not disagree I should add).
Smoking is a contributory factor to a lot of chronic illnesses and serious disease. Cancer, heart disease, bronchitis, emphysema, COPD, DVT, asthma, off the top of my head.
But it is not the only factor, or the only determinant. To take the obvious one - lung cancer. People who smoke get lung cancer. People who don't smoke also get lung cancer. People who smoked 40 or more Woodbines a day lived to the age of 80 something or 90 something. Maybe they ate well, or had an active lifestyle. Maybe they were just lucky.
Life and health are not so simple that any of us should be pointing fingers and saying "You can't have treatment because what you have done is self-inflicted."
Let's take this further. I like to go cycling. A healthy pursuit, yes? Or no? It's dangerous. I shouldn't be on the road. I might get knocked off and killed by a driver. A driver, who, in Spain, is legally required to remain a minimum of two metres away from a cyclist.
So why is cycling dangerous? Because some drivers break the law, drive badly, and knock cyclists off. Someone else's illegal and dangerous driving should stop me from a healthy and enjoyable exercise? I don't think so. They shouldn't be driving, not I shouldn't be cycling, or not treated for an accident incurred while cycling.
Now what else? Oh, fat people. They shouldn't have weight-reducing operations because it is all self-inflicted. In fact they shouldn't have any operations because the risk is too great and no-one wants to be sued if the operation goes wrong (because they are so fat etc etc).
I should declare a slight interest here. My BMI has increased from 18 something to 20 something so I am very sad. I don't think I am approaching obesity yet. So that won't be an immediate burden for the health services to consider.
Fertility treatment. I have met a number of women who have undergone fertility treatment, and it doesn't work for everyone. When I worked in the health service we went down the controversial road of rationing fertility treatment. Is the inability to conceive an illness? Should it take precedence over life-threatening diseases or serious accidents?
The trouble is when you try and prioritise funding for health services (the pot is limited in case anyone is unaware of that) people do not want to play. Self-interest always takes precedence.
Plastic surgery. Another health service tale from my previous life. The young woman whose GP put her forward for breast augmentation to boost her self esteem, her breasts and her modelling career. For which, incidentally, I totally blame our appalling sexist society that she felt she needed to have bigger breasts in order to feel good or succeed in life.
I have a very simplistic view of health - or sickness - services these days. I think priority for funding should be for emergency treatment and serious illnesses. By serious illness I mean life-threatening or chronic (long-term) illness that ruins people's quality of life and mental illness that similarly can make a devastating impact on people's lives and that of their carers and their families.
Or to put it another way, wanting something you haven't got - whether it be large breasts or children - wouldn't be my choice for priority funding.
So to come round full circle to my opening point, I would never advocate the refusal of treatment for someone who has smoked, or taken drugs, or made the "wrong" choices in life. I think a health service should be there for everyone, but funding choices do have to be made.
And if someone thinks large breasts or a desire for a child is more important than treating someone with COPD, or heart disease or easing the last few days for someone with lung cancer, who am I to argue?
We live in a must-have society.